Physical Examination of the Abdomen

Question 1

What are the core examination skills in an abdominal exam?

Answer 1

Inspection, auscultation, percussion, palpation.

Question 2

What types of medications are concerning for a patient with constipation?

Answer 2

Antihistamines and narcotics.

Question 3

What should you do to prepare and position your patient for an abdominal exam?

Answer 3

1) Patient should have an empty bladder.
2) Approach patient from their right side.
3) Place patient supine with knees slightly flexed and feet flat on bed.
4) Fully expose abdomen.
5) Ensure patient is comfortable.

Question 4

What should you ask female patients complaining of GI issues?

Answer 4

First day of last menstrual period.

Question 5

Why should you have your patient take a deep breath and hold during an abdominal exam?

Answer 5

It lowers the diaphragm.

Question 6

What occurs when you have your patient lift his head off of the table when he is laying supine?

Answer 6

It contracts the rectus abdominis muscles. The rectus will contract or show signs of separation indicative of diastasis recti, hernia, or masses.

Question 7

Visible intestinal peristalsis may indicate what?

Answer 7

Intestinal obstruction

• Males: abdominal movement
• Females: costal movement

Venous patterns

Lesions

Question 8

What are Cullen sign and Gray-turner sign, and what do they indicate?

Answer 8

Cullen: bluish periumbilical discoloration that suggests intraabdominal bleeding.

Gray-Turner: bluish flank discoloration suggests retroperitoneal or intraabdominal bleeding.

Question 9

Purplish striae on the abdomen, moon face and buffalo hump are indicative of what condition?

Answer 9

Cushing Syndrome

Question 10

Asymmetrical distention may indicate what disorders?

Answer 10

Hernia, tumors, cysts, bowel obstruction, enlargement of abdominal organs.

Question 11

How are bowel sounds heard during auscultation, and how long do you listen to them?

Answer 11

They are heard as clicks and gurgles that occur irregularly and range from 5-35 per minute.

You must listen for 5 minutes to document absent bowel sounds.

Question 12

What are borborygmi?

Answer 12

Loud, prolonged gurgles.

Question 13

Increased bowel sounds can be caused by what conditions?

Answer 13

Gastroenteritis, early intestinal obstruction, hunger

Question 14

A high pitched tinkling sound indicates what?

Answer 14

Intestinal fluid and air under pressure, as in early obstruction.

Question 15

Decreased bowel sounds occur with what conditions?

Answer 15

Peritonitis and paralytic ileus.

Question 16

When percussing the abdomen, why do you start with overall percussion?

Answer 16

To get a sense of overall tympany and dullness.

Examine tender/painful areas last.

Note size and density of abdominal organs.

Question 17

The dullness of a healthy spleen is often obscured by what?

Answer 17

Colonic air.

Question 18

What is the average size of the liver?

Answer 18

6-12cm.

Question 19

The gastric bubble is ____ in pitch than normal tympany of the intestine.

Answer 19

Lower

Question 20

What is the landmark for percussing the kidneys, and what position do you place your patient?

Answer 20

Costovertebral angle, sitting

Question 21

What are ascites?

Answer 21

Excessive intraabdominal fluid buildup

Question 22

When palpating the epigastric area for aortic pulsation, what sensation is indicative of an aortic aneurysm?

Answer 22

A prominent lateral pulsation.

Question 23

What is ballottement used to assess?

Answer 23

Floating masses.

Question 24

A positive rebound tenderness test appears in what manner, and indicates what?

Answer 24

Sharp stabbing pain when you remove your hand from their abdomen at the site of peritoneal inflammation. (Blumberg sign)

Rebound tenderness over McBurney’s point in the RLQ suggests appendicitis (positive McBurney’s).

Question 25

The Markle test is used to assess what?

Answer 25

Peritoneal irritation. A positive test will illicit abdominal pain.

Question 26

Rovsing sign is used to assess what? What is a positive finding?

Answer 26

Appendicitis. Increased RLQ pain with palpation of the LLQ is positive.

Question 27

What is the iliopsoas muscle test used for? What is a positive finding?

Answer 27

Used to test for appendicitis (i.e. retrocecal appendicitis). Pain in the abdomen is a positive sign.

Question 28

What is the obturator muscle test used for, and what is a positive finding?

Answer 28

Used to assess for appendicitis or pelvic abscess. Abdominal pain is a positive finding.

Question 29

What test is used to assess for gallbladder irritation?

Answer 29

Murphy’s sign. Abrupt cessation of inspiration during this test is a positive finding and is suggestive of cholecystitis.

Question 30

What is the reason for asking your patient to bear down during a rectal exam?

Answer 30

To make fistulas, fissures, rectal prolapses, polyps, and internal hemorrhoids more apparent.

Question 31

During a rectal exam of the anal ring, you note that your patient’s sphincter is lax. What could be the cause?

Answer 31

Neurological injury or deficit.

Question 32

What surface of the prostate gland will be palpable during a rectal exam?

Answer 32

The posterior surface of the gland palpable through the anterior rectal wall.

Question 33

What stool characteristics require a digital rectal exam?

Answer 33

Persistent pencil like stool
-Permanent stenosis from scarring or malignancy

Light tan/gray stool
-Obstructive jaundice

Tarry black stool
-Upper GI bleed

Bright red blood in stool
-Lower GI bleed

Question 34

A stony, hard nodular prostate indicates what?

Answer 34

Carcinoma, calculi, chronic fibrosis.

Question 35

A fluctuant, soft prostate indicates what?

Answer 35

Prostatic abscess

Question 36

Tenderness and inflammation of the perianal area suggests what?

Answer 36

Abscess, anorectal fistula or fissure, pilonidal cyst, pruritus ani

Question 37

What is the normal size of the prostate gland?

Answer 37

4cm in diameter and no less than 1cm protrusion into the rectum